Dr. Edward V. Loftus Jr., AGAF, is professor of medicine and director of the infammatory bowel disease interest group, division of
gastroenterology and hepatology, at the Mayo Clinic, Rochester,
Minn. He has consulted for and received research support from
UCB, AbbVie, and Janssen.

The possibility that intraepithe- lial neoplasia or dysplasia of the uterine cervix might occur more frequently in women with inflammatory bowel dis- ease (IBD) was raised almost

10 years ago. It stands to reason that
some women with Crohn’s disease or
ulcerative colitis might be at increased
risk of cervical dysplasia – after all, the
primary driver of cervical neoplasia is
infection with human papillomavirus,
many patients with IBD are on drugs
that suppress the immune system, and
other immunosuppressive states (for
example, HIV infection, post organ
transplant) have been associated with
higher rates of cervical dysplasia and
cancer. However, the results of studies
on this question have been conflicting.

These researchers from the StatensSerum Institut in Copenhagen haveharnessed the power of the nationwideDanish medical informatics system toanswer many epidemiologic questionsabout various aspects of IBD. The re-searchers identified a cohort of morethan 18,000 women with ulcerativecolitis, more than 8,000 women withCrohn’s, and more than 1.5 millionwomen with neither, and “followed”them through a pathology registry forcervical dysplasia and through a cancerregistry for cervical cancer. Access to aprescription registry allowed stratifi-cation of risk based on medication use.Careful review of the methods sectionof the paper suggests that this studywas well designed and executed.Women with ulcerative colitis wereabout 15% more likely than controls todevelop dysplasia, but the cancer riskwas not increased. Women with Crohn’sdisease were about 25% more likely todevelop dysplasia relative to controls andmore than 50% more likely to developcervical cancer. There were no signifi-cant differences in neoplasia risk whenstratified by medication use, althoughthere were trends toward increasedrisk of high-grade cervical dysplasia inwomen with Crohn’s disease who wereprescribed azathioprine or anti–tumornecrosis factor agents. Interestingly, therisk of cervical neoplasia was elevated inwomen well before the diagnosis of IBD.The study confirms that there is anelevated risk of cervical dysplasia andcancer among women with IBD, andthat the risk seems slightly higher inthose with Crohn’s disease. The findingof the increased risk of neoplasia wellbefore the diagnosis of IBD suggeststhat perhaps a relative state of immu-nosuppression exists in patients whoare ultimately diagnosed with IBD. Insome respects, I found this to be themost intriguing aspect of the paper, andit needs to be explored further in bothprospective and retrospective studies. n